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A Review of the GOLD Guidelines for the Diagnosis and Treatment of Patients With COPD: Management of COPD

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Management of COPD

After a diagnosis of COPD has been made, the goals of treatment should include relief of symptoms, amelioration of disease progression, improvement of patients' exercise tolerance and health status, prevention and treatment of complications and exacerbations, and a reduction in the risk of death from by COPD. Successful strategies for the clinical management of COPD should include measures for the assessing and monitoring the disease, reducing risk factors, a treatment plan for achieving stable disease, and tactics for managing stable COPD and acute exacerbations of the disease.[1] While there are a number of aspects of disease management that may be standard for all patients, healthcare providers and patients need to establish realistic goals and understand that these goals will vary between patients. Treatment for COPD depends on the severity of the disease and health status of the patient, which should be evaluated based on symptom severity and impact of these symptoms on QoL and not solely on the extent of airflow limitation.[1] Components of treatment plans include smoking cessation strategies, pharmacologic management of the symptoms of COPD and related complications and comorbid conditions, as well as non-pharmacologic interventions, such as risk factor reduction, patient counselling, mechanical bronchial hygiene, pulmonary rehabilitation, oxygen therapy, and in some cases, surgery to improve lung mechanics (Table 3).[1] Overall assessments should be made not only at the patient's initial workup, but also at subsequent visits to evaluate the benefit (or lack of benefit) attributable to each pharmacologic and non-pharmacologic component of the COPD management strategy as well as to identify areas that might require improvement and additional intervention.[1]

Planned care management for COPD can limit exacerbations experienced by patients, or enable early recognition that may result in more effective treatment.[31] A support team comprised of both physician and support-service personnel regularly follow-up with the patient to provide education, reinforce medication adherence and smoking cessation when applicable, and encourage a healthy lifestyle. Regularly scheduled physician visits are also encouraged, to monitor disease and prevent acute care visits.[1] Planned care not only improves QoL for the COPD patient and caregivers,[32] but can reduce the economic burden incurred by hospitalisations and emergency visits.[33]

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